Heart failure: to digitalise or not? The view against.

Abstract

Despite extensive clinical experience the role of digoxin is still not well defined. In patients with atrial fibrillation digoxin is beneficial for ventricular rate control. For patients in sinus rhythm and heart failure the situation is less clear. Digoxin has a narrow therapeutic:toxic ratio and concentrations are affected by a number of drugs. Also, digoxin has undesirable effects such as increasing peripheral resistance and myocardial demands, and causing arrhythmias. There is a paucity of data from well-designed trials. The trials that are available are generally small with limitations in design and these show variation in patient benefit. More convincing evidence is required showing that digoxin improves symptoms or exercise capacity. Furthermore, no trial has had sufficient power to evaluate mortality. Pooled analysis of the effects of other inotropic drugs shows an excess mortality and there is a possibility that digoxin may increase mortality after myocardial infarction (MI). Angiotensin-converting enzyme (ACE) inhibitors should be used first as they are safer, do not require blood level monitoring, modify progression of disease, relieve symptoms, improve exercise tolerance and reduce mortality. Caution should be exercised in using digoxin until large mortality trials are completed showing either benefit or harm. Until then digoxin should be considered a third-line therapy.

• Authors: H D White
• Journal: Australian and New Zealand journal of medicine (Aust N Z J Med) Vol. 22 Issue 5 Suppl Pg. 626-30 (Oct 1992) ISSN: 0004-8291 [Print] Australia
• PMID: 1449452 (Publication Type: Comparative Study, Journal Article, Review)

Chemical References

• Angiotensin-Converting Enzyme Inhibitors
• Digoxin

Topics

• Angiotensin-Converting Enzyme Inhibitors (pharmacology)
• Digoxin (adverse effects, pharmacokinetics, therapeutic use)
• Drug Interactions
• Heart Failure (drug therapy)
• Humans